How Accurate is Epidemiology? (part 3)

To my previous post about Gary Taubes’s NY Times article, Andrew Gelman adds that it is good to see public discussion of these issues. I agree. I also like seeing them raised in a dramatic context: Who’s right? Powerful people making serious mistakes. How will we know? Health at risk! That sort of thing.

Speaking of drama and epidemiology . . . For many years the introductory epidemiology class for graduate students in the UC Berkeley School of Public Health was taught by Leonard Syme. I learned about this class at party. I spoke to someone who had taken it and, as a result, had switched from public policy to epidemiology. Very impressive. I knew Syme slightly. I went to his office to learn more about how he had managed to influence someone so much. “Lots of students have said that,” he told me as I entered his office. Lots of students, after taking his class, had decided to become epidemiologists. The list included Michael Marmot, one of the most important epidemiologists in the world, who studies the social gradient in health — the tendency for the people at the top to be healthier than the people at the bottom, even after controlling for all sorts of things.

The class met once/week. Every week there was a new topic. For every topic Syme would assign a paper laying out the conventional wisdom — that high cholesterol causes heart disease, for example — plus three or four papers that cast doubt on that conclusion. I think he even had American Heart Association internal emails. Several students would present the material and then there would be debate — what’s to be believed? The debates were intense. If ever the students seemed to be reaching agreement, he would say something to derail it. “You know, there was a study that found . . . ”

Practically all classes make you think you know more at the end of them than you knew when they began. Practically all professors believe this is proper and good and cannot imagine anything else. With Syme’s class, the opposite happened: Your beliefs were undermined. You walked out knowing less than when you walked in. You had been sure that X causes Y; now you were unsure. At first, Syme said, many students found it hard to take. A three-hour debate with no resolution. They did not like the uncertainty that it produced. But eventually they got used to it.

The overall effect of Syme’s class was to make students think that epidemiology was important and difficult — even exciting. It was important because we really didn’t know the answers to big questions, like how to reduce heart disease; and it was difficult and exciting because the answers were not nearly as obvious as we had been told. This is why many students switched careers.

Marmot on Syme: “I have never come across anyone in the academic world who had quite the powerful influence on students that Syme did.” Nor have I. That meeting with Syme, about five years ago, was one of two conversations in my life that really taught me something about how to teach. I was the only person at Berkeley to ever ask him about his teaching, Syme said. What a pity.

Syme on how his research began.

5 Responses to “How Accurate is Epidemiology? (part 3)”

  1. links for 2007-09-20 « Matthew Henty Says:

    […] Seth’s blog » Blog Archive » How Accurate is Epidemiology? (part 3) THIS is how to learn and teach (tags: science learning teaching) […]

  2. Seth’s blog » Blog Archive » How Accurate is Epidemiology? (part 4) Says:

    […] How Accurate is Epidemiology? (part 3) […]

  3. Seth’s blog » Blog Archive » Leonard Syme on Teaching Says:

    […] How Accurate is Epidemiology? (part 3) […]

  4. Seth’s blog » Blog Archive » Nassim Taleb on Incompetent Experts Says:

    […] I don’t think conventional research in nutrition, clinical psychology, or psychiatry is worthless — far from it. I think it is very valuable. (For one thing, it helped me see that my self-experimental conclusions, as unorthodox as they were, had plenty of empirical support.) What is hard for outsiders to grasp is how what they see — what they read in magazines and newspapers and even books — is heavily filtered to conform to a party line. Plenty of research supports the Shangri-La Diet, for example (such as research about the set point theory of weight control), but you are unlikely to read about it in, say, The New Yorker because it doesn’t fit conventional ideas. Plenty of conventional research supports my ideas about mood, but you are unlikely to read about that research because it doesn’t support the party line of “dopamine imbalance” causing depression or whatever. This is what Leonard Syme taught his public-health students — that the party line was a lot more questionable than an outsider would ever guess. They hadn’t heard that before. (And it was unpleasant: Uncertainty is unpleasant.) This is a third sort of filtering: What data reaches outsiders. […]

  5. Seth’s blog » Blog Archive » Three Things Elizabeth Kolbert Doesn’t Know Says:

    […] 1. For years, as I’ve blogged, Leonard Syme, an epidemiology prof at Berkeley, taught his students to distrust one mainstream public-health conclusion after another. Maybe 12 examples in all. He showed them facts they didn’t know. All of a sudden the picture wasn’t so clear any more. That he could do this in so many cases, one case per week, is what’s telling. […]

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